Razi Journal of Medical Sciences

    Background & Aim: Breast carcinoma is the most common malignant tumor and the leading cause of death from carcinoma in women. Tumor grading is important as a prognostic factor in the treatment of patients and is routinely done on histologic specimens. Although breast cytology is a proven diagnostic technique in clinical practice, its use is frequently limited to establishing the benign or malignant character of a given lesion. However, a number of authors have shown that this method can provide additional information about tumor grading and its prognosis. The main objective of this study is to evaluate the importance of cytologic grading of breast carcinoma and its association with histologic grading. Material & Method: In the present study, 73 samples of open biopsy for frozen section examination which were sent to the pathology department of Rasoul-e-Akram and Milad hospitals between 2004 and 2005 were selected. Touch-imprint or scraping was used to prepare smears which were then stained by pap and rapid H&E methods. The smears were evaluated based on the grading system described by khan et al which takes 6 parameters into account: pleomorphism, nuclear size, nuclear margin, naked nuclear size, nucleoli and mitotic counts. Histologic samples were evaluated based on the Nottingham modification of the Bloom-Richardson system. Results: The 73 cases included 67 ductal carcinoma NOS(Non-Otherwise Specified), 2 papillary, 1 tubular, 1 lobular, 1 medullary, and 1 cribriform. The concordance rate between cytologic and histologic grading was 76.7%, which is nearly identical to the past study results. The concordance rate for grade-I tumors was 69.2%, grade-II 85.7% and grade-III 61.1%. 5 out of 6 parameters including pleomorphism, nuclear size, naked nuclear size, nuclear margin, and mitotic counts were statistically significant(P-value<0.05). Necrosis had a significant relation with histologic grading but was not used for scoring. Nucleoli, cell dispersion, cellularity, and tubule formation were not statistically significant. Also, there was no statistically significant correlation between cytologic grading and lymph node metastasis. Conclusion: In summary, expertise and sophistication in breast cancer cytopathology and cytologic grading have developed significantly in recent years. This information should be assimilated into the pre-operative plan so that the biologic behavior of the tumor can be determined in order to avoid a blind therapeutic approach. Prospective follow-up studies are needed to evaluate these cytodiagnostic criteria for cytologic grading of breast carcinoma.